Role of Radiographs in the Dental Hygiene Diagnosis 1.Calculus detection (not to be used to diagnose calculus code but can serve as an adjuct) Calculus can be seen in the interproximal areas of the teeth. It is important to note this in the radiographs as a dental hygienist in order to confirm a piece of calculus that needs to be removed or to even determine what type of instrument is to be used when removing that piece of calculus.
2. Caries detection: radiographs can be used in caries detection in between the contacts which is why it is important to have open contacts on all the radiographs. The appearance of the caries in between the teeth will appear radiolucent. The amount of caries and location will give the dental health care professional insight into the oral health needs of the patient. Patients with high caries rate may need additional nutrition counseling as well as OHI instruction and modfactions.
3.Periodontology ADA and AAP: It is important to note that bone loss is always greater than it appears on radiographs.
Bone loss on a radiograph displays the amount of bone remaining in periodontal disease. Due to angualtion of the PID the radiographic apperance of the aveolar crest can range from 0mm to 1.6mm.
Bone levels 1-2mm from the CEJ is considered to be a class ADAI or normal bone level.
Bone levels 3-4mm from the CEJ is considered to be a class ADAII or early periodontitist. In this type of periodontal disease one would most likely see horizontal bone loss.
Bone levels 5-6mm from the CEJ is considered to be a class ADAIII or Moderate periodontitist. In this type of periodontal disease the bone loss is horizontal or vertical.
Bone levels higher than 6mm is considered to be Advanced periodontist. Horizontal and vertical bone loss is visible radiographically.
Furcation involvement: Definitive diagnosis of furcation involvement is done by clinic examination by using a Nabers probe. Radiographs can be used as an aid to confirm or as an adjuct to help display areas that may have been missed clinically.
ADAII: Class I furcation may be present clinically but not radiographically
ADAIII: Class I or II furcation clinically and radiographically
ADAIV: Class II or III furcation clinically and radiogrpahically.
4.Pathology: Radiographs can be used to detect possible pathology. As a dental hygienist, we cannot diagnose the pathology but we can detect it and be able to describe it and give a differential diagnosis. It is detected as either radiopaque, radiolucent, or both.
5. Tooth development- Tooth development can be seen in radiographs and it can be shown if a child’s teeth are crowding as well as any problems that can be seen with the tooth development. In addition, impacted or partially erupted teeth can be determined radiographically.
6.Health of the periodontium and oral cavity (lamina dura, PDL (space etc.)
The earliest radiographic sign of peridontal disease is a break or fuzzyness in the lamina dura which is from an extension of gingival inflammation into the bone(Carranza p.565). The reason the etiology of fuzzy lamina dura is due to widening of the vessel channels and reduction of calcified tissue at the inderdental septum.
7.Restorations (overhangs etc.)
The primary method of detecting restorations is through clinical observations. Clinically a skilled clinician can detect: the type of restoration, breaks in the margins, rough/scratched restorations, and overhangs. Radiographs can be used in addition to clinical detection can not be used in replace of. Restorative overhangs and poor restorations can increase the likely hood of a patient infecting the tooth as well as surrounding teeth and must be corrected. Radiographs are also helpful to determine endonic treatment. Amalgam fillings are radiopaque, while composite fillings are a bit harder to detect because they are much lighter radiopaque shade compared to amalgams.
1.Calculus detection (not to be used to diagnose calculus code but can serve as an adjuct) Calculus can be seen in the interproximal areas of the teeth. It is important to note this in the radiographs as a dental hygienist in order to confirm a piece of calculus that needs to be removed or to even determine what type of instrument is to be used when removing that piece of calculus.
2. Caries detection: radiographs can be used in caries detection in between the contacts which is why it is important to have open contacts on all the radiographs. The appearance of the caries in between the teeth will appear radiolucent. The amount of caries and location will give the dental health care professional insight into the oral health needs of the patient. Patients with high caries rate may need additional nutrition counseling as well as OHI instruction and modfactions.
3.Periodontology ADA and AAP: It is important to note that bone loss is always greater than it appears on radiographs.
Bone levels 1-2mm from the CEJ is considered to be a class ADAI or normal bone level.
Bone levels 3-4mm from the CEJ is considered to be a class ADAII or early periodontitist. In this type of periodontal disease one would most likely see horizontal bone loss.
Bone levels 5-6mm from the CEJ is considered to be a class ADAIII or Moderate periodontitist. In this type of periodontal disease the bone loss is horizontal or vertical.
Bone levels higher than 6mm is considered to be Advanced periodontist. Horizontal and vertical bone loss is visible radiographically.
ADAII: Class I furcation may be present clinically but not radiographically
ADAIII: Class I or II furcation clinically and radiographically
ADAIV: Class II or III furcation clinically and radiogrpahically.
4.Pathology: Radiographs can be used to detect possible pathology. As a dental hygienist, we cannot diagnose the pathology but we can detect it and be able to describe it and give a differential diagnosis. It is detected as either radiopaque, radiolucent, or both.
5. Tooth development- Tooth development can be seen in radiographs and it can be shown if a child’s teeth are crowding as well as any problems that can be seen with the tooth development. In addition, impacted or partially erupted teeth can be determined radiographically.
6.Health of the periodontium and oral cavity (lamina dura, PDL (space etc.)
The earliest radiographic sign of peridontal disease is a break or fuzzyness in the lamina dura which is from an extension of gingival inflammation into the bone(Carranza p.565). The reason the etiology of fuzzy lamina dura is due to widening of the vessel channels and reduction of calcified tissue at the inderdental septum.
7.Restorations (overhangs etc.)
The primary method of detecting restorations is through clinical observations. Clinically a skilled clinician can detect: the type of restoration, breaks in the margins, rough/scratched restorations, and overhangs. Radiographs can be used in addition to clinical detection can not be used in replace of. Restorative overhangs and poor restorations can increase the likely hood of a patient infecting the tooth as well as surrounding teeth and must be corrected. Radiographs are also helpful to determine endonic treatment. Amalgam fillings are radiopaque, while composite fillings are a bit harder to detect because they are much lighter radiopaque shade compared to amalgams.